Costs of supplemental donor human milk on par with formula for preemies

Last Updated: 2018-02-28

By Megan Brooks

NEW YORK (Reuters Health) - For very-low-birth-weight (VLBW) infants, the cost of supplemental donor human milk (DHM) is about the same as preterm formula, according to a cost-effectiveness analysis of a Canadian study.

Compared with formula, supplemental DHM is associated with a lower incidence of necrotizing enterocolitis (NEC) in VLBW infants, but until now, the cost-effectiveness of DHM in this population from a societal perspective up to 18 months' corrected age was unknown.

Dr. Deborah O'Connor from the University of Toronto and colleagues looked at this issue in the Donor Milk for Improved Neurodevelopmental Outcomes study - a double-blind, randomized controlled trial that enrolled 363 VLBW infants (mean birth weight, 996 grams) from tertiary neonatal ICUs in southern Ontario.

The main results from the study, reported in JAMA in 2016 (http://bit.ly/2ox9cPm), showed that VLBW infants fed fortified DHM as a supplement to maternal milk had neurodevelopmental outcomes similar to those of their peers supplemented with formula. A preplanned analysis found a lower incidence of any-stage NEC in the DHM group (3.9% vs. 11.0%; P=0.01).

The cost-effectiveness analysis, reported online February 28 in Pediatrics, found similar average total costs out to 18 months' corrected age of supplementing with DHM and preterm formula. The average costs in 2015 Canadian dollars were $217,624 and $217,245, respectively.

"In fact, we found some evidence that total costs after hospital discharge were less in infants supplemented with donor milk," Dr. O'Connor told Reuters Health by email.

The researchers calculate that DHM cost an additional $5,328 (2015 Canadian dollars) per case of NEC averted by providing supplemental DHM. They caution, however, that there is "broad uncertainty" about this estimate. Nonetheless, Dr. O'Connor said, "given the short- and long-term sequelae associated with NEC and data presented in our study suggesting no difference in costs during initial hospitalization and potential cost-saving after discharge, use of supplemental donor milk over preterm formula is warranted."

"This is the first prospective cost-effectiveness analysis of DHM alongside a blinded RCT, and involved comprehensive analysis of infant-level costs," the researchers note in their article. "This experimental approach to health policy minimizes bias, optimizes internal validity, and permits simultaneous consideration of actual cost and effect distributions without the assumptions inherent in modeling studies. Moreover, unlike most formal economic evaluations in the neonatal trial literature, this analysis took a societal perspective, in which an attempt was made to capture all costs related to preterm birth to 18 months' corrected age, including parental out-of-pocket expenses."

The fact that the study was done in a single urban Canadian area is a limitation and might preclude generalizing the results to other settings in which mother's milk feeding or costs might differ.

"Canada and the U.S. share many similar approaches to caring for very-low-birth-weight infants, but our health care systems do differ. Nonetheless, the main conclusion, that donor milk is economically justifiable for very-low-birth-weight infants, would be expected to hold in the U.S. as well," Dr. O'Connor told Reuters Health.

The study had no commercial funding, and the authors disclosed no conflicts of interest.